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Fresh Start Campaign Materials Order Form
Thank you for your interest in the Fresh Start campaign.
Please select the material and quantity you would like to request. Contact us if you have questions or need help:
doh.freshstart@alaska.gov
Materials are available only in Alaska.
*
Contact Information
(Required.)
First name
*
Last name
Organization name
Email Address
*
Phone Number
*
Shipping Address
(Required.)
Address
Address 2
City/Town
ZIP/Postal Code
11" X 17" Poster
Enter Quantity
4"X9" Rack card
Enter Quantity
8.5" X 11" One-sheet
Enter Quantity
Tear-away 2"x3.5" cards (stacks of 50)
Enter Quantity of Stacks
Dementia Brochure
Enter Quantity
8.5" X 11" Dementia One-sheet
Enter Quantity
Special delivery requests:
*
How did you hear about the Fresh Start campaign?
(Required.)
On broadcast TV channels
On streaming TV, like Hulu
On the radio
On YouTube
On Facebook
On other social media (like Instagram)
In an email message
Elsewhere on the Internet (website, blog, online ad, Google or online search)
On a bus
On a poster or handout
At a health care provider’s office or health care facility
At a health fair or community event
Received Fresh Start materials before, reordering
Other (please specify below)
If you selected "Other" above, please specify where you heard about the Fresh Start campaign?
